Referential Ambiguity in the Narrative Productions of African American Adults Proposal for CAC 2014

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Outcomes from an intensive comprehensive aphasia program (ICAP): A retrospective look

Intensive comprehensive aphasia programs (ICAPs) are increasingly sought-after by consumers. It is important to examine outcomes from this unique clinical service model to determine feasibility, effectiveness, and potentially, to determine profiles of patient recovery. This poster presents retrospective data from first time participants in one ICAP over a 5 year period. Findings demonstrate significant improvements on language and activity/participation measures from pre-treatment to post-treatment

How difficult is it? How well Adults with Aphasia Perceive Task Demands

Researchers investigating self-ratings of task difficulty and effort allocated to lexical decision tasks in adults with aphasia indicated a mismatch between their perceptions and behavioral performance (e.g. Clark & Robin, 1995; Murray et al., 1997a; Murray et al., 1997b). That is, although participants with aphasia performed more poorly on the language tasks, they did not rate the tasks as more difficult (Murray et al., 1997a, 1997b) or as requiring more effort (Clark & Robin, 1995) compared to control participants. Murray et al., (1997a) reported that this impaired relationship between performance and perceptions was only found for difficulty ratings and not for ratings of perceived accuracy, leading them to conclude that individuals with aphasia are impaired in their ability to perceive the demands of the tasks. The purpose of the current study was to extend these findings by including both pre- and post-task ratings of difficulty for verbal and spatial tasks. We hypothesized that if participants with aphasia are misperceiving the demands of the tasks, the relationship between performance and ratings of difficulty would be less for the pre-task ratings compared to the post-task ratings. Comparing the relationship between difficulty ratings and performance on non-verbal (spatial) and verbal tasks would further reveal whether any deficits in perceiving the task demands are specific to verbal stimuli or a domain-general deficit in evaluating task demands

Impact of Personalization on Acquisition and Generalization of Script Training: A Preliminary Analysis

Eight individuals with chronic aphasia underwent intensive computer-based script training. Trained and untrained generalization scripts, matched for length and complexity, were developed. The two scripts shared personalized and non-personalized words/phrases. Training lasted three weeks. Script performance was probed periodically. For acquisition, the gain from baseline to post-treatment for both personalized and non-personalized words/phrases on the trained script was significant; the effect size of personalization over non-personalization was moderate. For generalization, the gain for both personalized and non-personalized items was also significant, but the effect size of personalization over non-personalization was small. Limitations of the study are discussed

Modeling the relationship between discourse and confrontation naming

The cardinal deficit of people with aphasia (PWA) is anomia (Goodglass & Wingfield, 1997). In single word retrieval, as in picture naming tasks, this deficit is believed to be indicative of disruption in two cognitive processes: (i) accessing a semantic description of the target concept, and/or (ii) retrieval of a fully phonologically specified representation (e.g., Dell, 1986). During discourse, in addition to these core processes that serve word retrieval of single words, production also depends on “…factors external to the lexicon…” (p. 169, Wilshire & McCarthy, 2002). The latter processes might influence the selection of lexical items based on syntactic, structural, and/or pragmatic criteria that can be either automatic or meta-cognitive. The current study investigates the implicit assumption that performance in single-word, picture naming tasks is directly and strongly related to word retrieval performance during discourse production. To establish a diagnosis and quantify its severity, and determine the effect of treatment in various communication disorders, speech language pathologists often use confrontation naming tests (CNTs). In CNT’s, basic drawings or pictures are presented to the PWA who is asked to name its target. The results of the test are then used to determine what steps should be taken post-injury to support the client’s word-production/word retrieval process and which therapeutic approach may maximize the rehabilitation outcome. However, according to Herbert, et al (2008) CNTs may not fully take into account their non-native disposition. First, in typical conversation speakers do not name pictured objects. Also, in CNTs, examinees name bare nouns or verbs and there are no elements in which to attach these words (i.e. not conversational context). Second, the main ideas communicated in discourse may not be necessarily planned: based on Dell’s model, access to word specific semantic features, retrieval of the word form, and encoding the corresponding phonemes of that word are all part of the natural steps that occur, typically without premeditated action in the healthy, non-injured brain (Martin, 2012). Based on these premises authors have argued that decontextualized tasks such as CNT’s may “… [bear] little resemblance to the online, multifaceted word retrieval required during conversation” (Mayer & Murray, 2003, p. 482). This position carries significant clinical and research implications because it directly challenges the idea of using CNT’s to make inferences about discourse production; and, argues that perhaps the decontextualized nature of such tests may mislead professionals when diagnosing and treating PWA if they are to rely solely upon them to make inferences about discourse production. The specific aims of this study were: 1. To assess whether there is a relationship between performance in CNT’s and the proportion of paraphasias in three different types of discourse when accounting for construct irrelevant variance (i.e. random noise and irrelevant systematic variance). 2. To determine the magnitude of the relationship between error free estimates of word retrieval at the single and discourse level. 3. To determine the relationship between observed scores in CNT’s and number of paraphasias in discourse

Frequency and co-occurrence of suppression and coarse coding deficits in adults with RHD

This study examines two language processing functions that have the potential to create socially handicapping language comprehension difficulties in adults with right hemisphere brain damage (RHD). The first, coarse semantic coding, allows normal comprehenders to bring to mind distant meanings or features of words that are appropriate in highly specific contexts (e.g., the "rotten" feature of the word "apple" in the context of spoiled produce). The second, suppression, is a process that inhibits contextually-irrelevant meanings (e.g., the "card-playing" meaning of the word "spade" in "He dug with the spade."). In prior work, some adults with RHD were found to have impaired suppression1-4 or coarse coding processes5-6. These language processing impairments can make it difficult for individuals with RHD to participate in everyday social communication. For example, they can have trouble thinking beyond the most typical instance of an entity (e.g., an apple that's red, round, and crunchy) when another instance is being referred to (e.g., an apple that's rotten). Another possibility is they can be misled by ambiguities which are commonplace in conversation, and have difficulty getting back on track (e.g., keeping in mind the "card-playing" meaning of the word "spade" in a sentence like "He dug with the spade"). These problems predict comprehension performance on measures of narrative comprehension, as well7,8. To date, there is no information about how prevalent these deficits are, or how often they may co-occur in the same individual. This project identifies the proportions of a sizeable group of adults with RHD that have either a coarse coding deficit, a suppression deficit, co-occurring deficits, or neither deficit in reference to criteria developed from prior studies of healthy control subjects1-3,5,6

Neural correlates of grammatical impairment in primary progressive aphasia

Primary progressive aphasia (PPA) is characterized by distinct patterns of left-lateralized neural degeneration and declining language functioning. Although deficits in grammatical processing (e.g., complex sentence production and comprehension, production of grammatical morphology) are primarily seen in the agrammatic variant (PPA-G), subtle impairments also may be observed in the logopenic (PPA-L) and semantic (PPA-S) variants (see Wilson, et al., 2012; Thompson & Mack, in press, for a review). In cognitively healthy individuals, production and comprehension of syntactically complex structures involves both the left middle temporal cortex (Ben-Shalom & Poeppel, 2008; Indefrey & Levelt, 2004) and the left inferior frontal and motor cortices (Friederici, 2002; Kielar et al., 2011; Shapiro, et al., 2012; Tyler et al., 2005), with similar regions engaged for production of grammatical morphology. However, impaired complex sentence production and comprehension in PPA has been linked primarily to atrophy in the left inferior frontal gyrus (IFG) (Amici et al., 2007; Rogalski et al., 2011; Wilson et al., 2011) and atrophy patterns associated with deficits in grammatical morphology have not been previously studied. The present study aimed to identify the cortical areas of atrophy associated with deficits in complex sentence production, complex sentence comprehension, and production of grammatical morphology in PPA. Identification of these patterns has relevance for understanding the neural mechanisms of grammatical processing and as well as for clinical management of individuals with PPA

Improving auditory access to low imageabilty words by embedding them in imageable semantic-syntactic contexts in a case of deep phonological dysphasia

Deep dysphasia is a relatively rare subcategory of aphasia, characterized by word repetition impairment and profound auditory-verbal short-term memory (AVSTM) limitation. Accuracy of word repetition is better for words than nonwords (lexicality effect) and better for high-image than low-image words (imageability effect). The cardinal feature of deep dysphasia is the occurrence of semantic errors in single word repetition (Howard & Franklin, 1988). Phonological dysphasia shares all of these features except that semantic errors in repetition appear in repetition of multiple words and sentences. Thus, it has been proposed that these two ‘syndromes’ are not distinct, but actually are based on an impairment of auditory-verbal STM that can vary by severity, leading to deep dysphasia when severe and phonological dysphasia when mild (Martin, Saffran & Dell, 1996; Ablinger, Ablel & Huber, 2008). First, we report a single case treatment study of a person whose pattern of word repetition performance was consistent with the continuum of phonological-deep dysphasia: poor repetition of nonwords, imageability effects in repetition of single and multiple words and semantic errors in repetition of multiple word utterances. Differences in processing abstract (i.e., low imageability) versus concrete (i.e., high image) have been considered recently in aphasic treatment protocols (Kiran, Sandberg & Abbott, 2009). Here we test the effects of a theoretically motivated treatment that manipulates the semantic cohesiveness of low imageability (i.e., abstract)-low frequency (LI-LF)words to improve access to and short-term retention of LI words in deep-phonological dysphasia. Following presentation of the treatment case study, we describe an experimental protocol to determine if this approach of increasing imageability of abstract words through syntactic and semantic contexts can be extended to other individuals who present along the deep--phonological dysphasia continuum

Word Retrieval Measures with the AphasiaBank Stimuli: Test-Retest Reliability Proposal for CAC 2014

Research into treatment for improving word retrieval ability in aphasia is increasingly focused on assessing outcomes at a discourse level. For example, the AphasiaBank project (http://talkbank.org/AphasiaBank/ ) uses a number of tasks to elicit discourses from individuals with aphasia. The discourses can then be analyzed with a set of analysis tools from the Computerized Language Analysis (CLAN) system. MacWhinney, Fromm, Holland, Forbes, & Wright (2010) have suggested that the AphasiaBank tools can be used to study recovery from aphasia and the effects of aphasia treatments. The AphasiaBank protocol is promising because of its ability to quickly and accurately perform a number of analyses that are time-consuming, cumbersome, and vulnerable to error when performed manually. However, except for a report on VOCD, a measure of lexical diversity that is part of the CLAN system (Boyle, 2013), there have been no reports about the test-retest reliability of the various language measures included in CLAN when they are used with the elicitation stimuli that are part of the AphasiaBank protocol. Test-retest reliability refers to the assessment of whether a test produces the same results on repeated application when the participants who are being tested have not changed on the domain that is being measured (Fitzpatrick, Davey, Buxton, & Jones, 1998). Before a measure is used as an outcome assessment, its test-retest reliability must be established, otherwise it is impossible to assert that changes on the measure are related to treatment rather than to spurious, day-to-day variability inherent in the measurement or the behavior it is measuring (Brookshire & Nicholas, 1994; Herbert, Hickin, Howard, Osborne, & Best, 2008). Test-retest reliability is as important for measures used to evaluate impairments as it is for those that measure change, since measures that are not stable will not provide valid or reliable assessments of impairments. Several measures available in the CLAN System can be used to assess word retrieval difficulty. To use CLAN, the discourses must first be transcribed and coded for errors and other behaviors of interest using a format specified in the CHAT Manual (http://talkbank.org/AphasiaBank/). CLAN can then be used to analyze the transcripts for the occurrence of the coded errors as well as for other language parameters. Word-finding problems that can be coded in CHAT include phonemic paraphasias, semantic paraphasias, neologisms, false starts, time fillers, and repetitions. The purpose of this investigation was to provide preliminary information about the test-retest reliability of these measurements in narrative discourses elicited with the AphasiaBank stimuli from speakers with aphasia

Comparing linguistic complexity and efficiency in conversations from Stimulation Therapy and Conversation Therapy in Aphasia

The ultimate goal for speech language pathology interventions for people with aphasia (PWA) is to be able to converse as normally as possible (Armstrong & Mortensen, 2006). However, there are numerous approaches to aphasia therapy as well as various outcome measures. For instance, Stimulation therapy (ST) relies on structured repetition and drill to elicit language, while conversation therapy (CT) uses client-clinician conversation and conversation analysis to improve everyday language. Most speech language pathologists use standardized tests or rating forms to measure treatment progress rather than measuring conversations (Boles, 1998). We aimed to compare differences in linguistic complexity and efficiency in conversational outcomes in two treatment types, ST and CT. Researchers have examined the verbal abilities of PWA and aging adults by analyzing language samples (Capilouto et al., 2005; Kemper & Sumner, 2001); however few people have examined linguistic complexity in conversation as a treatment outcome measure. Conversational efficiency measured in Correct Information Units (CIUs)/minute is a valid and reliable way to measure improvement in connected speech (Nicholas and Brookshire, 1993). Efficiency can be measured by calculating CIUs/minute or % CIUs. Researchers have used %CIUs to measure efficiency in conversations (Doyle, Goda & Spencer, 1995) and CIUs/minute in story-telling (Jacobs, 2001). However, no one has reported using CIUs/minute to measure efficiency during conversational interactions. To address this we asked the following questions: 1. Does CT lead to a greater increase in linguistic complexity than ST based on the following measures of linguistic complexity: a) Mean length of utterance (in words) (MLU)? b) Type/token ratio (TTR)? c) Number of different words (NDW)? d) Percent of utterance responses? e) Percent of simple utterances? f) Percent of complex utterances? g) Propositional density? 2. Does ST lead to improved efficiency of conversation? 3. Does CT lead to improved efficiency of conversation? 4. Is conversational efficiency different when ST is compared to CT? 5. Is there a difference between clinician and participant total talk time during conversation probes taken during both treatments